Saturday, August 3, 2013

Practicality: Teeth Brushing and Face Washing

Getting CM2 to brush his teeth and wash his face used to sent chills down my spine. There was no amount of cajoling, arguing or threatening him with a "computerectomy" that would get him to follow through on these two most basic hygiene functions. He just hated them. He did everything he could to avoid them. I never actually understood what the issue was, afterall his older brother who had a more "severe" case of autism took his hygiene seriously and practiced it diligently. Finally, after years of fighting with him I got a clue....sensory processing issues.

You need to understand that the boys, now in their twenties came of age when society and especially us parents were finally learning something about our children's issues. When Mr. GS was first diagnosed no one ever spoke of aspergers in any context whatsoever. There was pdd-nos, autistic and that was about it. Oh aspergers was out there. But until Tony Atwood came along, not one person that I had had contact with even spoke about it. Heck the only point of reference I had had about autism in general was the movie Rainman, just like everyone else. I had read something about Temple Grandin but her story made absolutely no sense to me. How could someone with autism become a university professor and a world-leader in animal husbandry I wondered?

Yet interestingly, the first point that the doctors made after diagnosing Mr. GS was to tell me that it wasn't my fault that he had autism. The "refrigerator mom" theory was even still widely accepted as gospel back only two decades ago. So sensory processing issues were not even in the back of my mind, the doctors' minds, the teachers' minds or anyone elses' when we were dealing with CM2's refusal to brush his teeth and wash his face.

In the beginning who had ever heard of sensory issues? In fact, my school district, which is amazing when it comes to special education, needs, and autism support would not provide support for sensory processing. Since it wasn't in the DSM, it apparently didn't exist according to them. Luckily CM2 needed OT for other issues and we just added in the teeth-brushing and face washing component along the way privately with the therapist.

So yes, if your child has a sensory issue, if they are seeking unusual amounts of texture, input or are overly sensitive to clothing, weather, even the texture of food, your child needs OT to help with their sensory intake and output. Believe me, when I tell you it helps. OT really does help them integrate their sensory issues. Of course, everything you also do in their lives to make them feel more comfortable in their skin and in their environment has a big effect as well.

Now CM2's sensory issues were even apparent in how he ate his food. He chipmunked his food. He would stuff his mouth so full of food until his cheeks bulged before he began to chew his food. It not only made for an unappetizing meal to watch him eat, but it was also a terrible choking hazard. We would have to monitor his bites very carefully (interestingly we still do but for other reasons as he now eats too fast) and give him instruction on how much chewing he needed before he put more food in his mouth. We would also need to remind him to swallow before he put more food in his mouth as well. For some reason the sensors in his mouth did not understand and transmit the necessary safety related points from his mouth to his brain.

And of course his oral sensory processing issue also manifested itself in teeth brushing. He hated, simply hated to brush his teeth. It was not any different when going to the dentist. They could not really brush his teeth (oh and forget about tooth polishing) but could clean them (at least get the tarter off as much as possible.) You just did not put anything into CM2's mouth. This did not just make him feel uncomfortable, I actually think that it may have hurt him in some way.

It's almost like auditory processing issues. An autistic self-advocate once explained to me that with auditory processing certain sounds don't just bother the person, they actually can cause alot of pain. So when CM2 used to put up a ruckus to avoid teethbrushing I understood what was behind it was a sense of being horribly uncomfortable, but unlike with auditory processing where the person can cover their ears or wear headphones to block out some noises, people need to brush their teeth. Here are a few ideas we have tried over the years:

Teeth Brushing ideas:

1. Very soft toothbrush. Something a small child learns on.
2. Hubby would help him and brush his teeth for him even well into the elementary school years.
3. We would allow him to pick out any toothpaste he wanted. Even the ones with the most disgusting flavors.
4. He liked certain cartoon characters, so we tried those in toothbrush form too (and on the toothpaste tube.)
5. We bought mouthwash. They have some children's mouthwashes that you need to use when your child gets braces so we started having him use that. It wasn't perfect, but at least it added to an attempt at oral health. He took a sip, swished it around and spit it out.
6. Finally we bought a battery operated/electric toothbrush. There are several kinds and we found that the one with the small round head seemed to work well for CM2. He complained less and brushed his teeth more. Not perfectly by any means, but at least the toothbrush went into the mouth cavity and stayed there for a few seconds. Note: Not only are the battery operated brushes alot cheaper than the electric ones but they come in many different colors and the children's ones come in character form too.
7. (Unfortunately) Break down and pay for extra dental cleanings every three months instead of every six.
8. See if a sticker chart helps. Maybe if the child earns enough stickers or points toward something they like then it will be an incentive to overcome the discomfort. Also don't expect a major brushing event. Start with a simple ten seconds of toothbrush in the mouth at first and work your way up. Once they see they can do it, they may even increase it up to the 2 minute required mark themselves.
9. If they use a weighted vest, let them wear it during teeth brushing. Or as in the case of CM2 let him carry with him his good luck butterfly paperweight. Anything that gives them comfort.

Face washing ideas:

What we learned was that CM2, like his brother, did not like getting his eyes wet.  We allowed them to wear goggles in the bathtub. So we let him wear goggles to wash his face in the morning. It definitely helped. Or he would also just rinse from nose down. Of course that tends to rule out washing out your eyes from "sleep," but I would also take a soft washcloth and just have him close his eyes and gently clean over the area. You could also use some of those make-up cotton balls to wash out their eyes as well. OK, yes this also means the child has to be cooperative and allow you near their eyes in the first place.

Another issue that I found out about is that it could be the running water on their skin that causes them discomfort. Another self-advocate once told me that showers were painful on her skin. The constant beating of the drops hurt her, while a still bath was fine. Maybe what you should try is fill the basin up with a little warm water and see if that helps get your child to wash his face.

And as with teeth brushing, do everything in increments. Don't expect them to be soaping up their face and allowing tons of water to splash them right away. Go slow with a little warm water, and over time add in soap and them put the two pieces together. Skin experts will tell you soap is very bad for the skin anyway. Maybe a nice cleanser (like neutrogena or aveeno) that you can put on and take off using cotton balls or extremely soft washcloths.


Now I am not saying that we still don't have issues with CM2 brushing his teeth and washing his face. He does a precursory job with the teeth brushing but it is getting better. The dentist even mentioned that fact the last time he was in for a checkup. Plus CM2 was able to wear braces for two years and his teeth are pretty straight. (However, when the orthodontist tried to put the braces on him the first time, the man did have to move fast in order to not get bit.) CM2 did have a hard time at first but he eventually got used to the braces. What he liked was being able to pick out the color of his rubber bands.  So he went around with a kelly-green mouth for years. It was an incentive of sorts. And yes we had teeth brushing issues when he wore the braces. We spent alot of time at the dentist getting his teeth cleaned. And has he worn his retainer since the braces came off?...Not on a bet.

The reality is that CM2 has these sensory issues. He, as a young adult, knows that he has to keep up his hygiene so that he remains healthy and accepted in society. Is it easy for him? No it is not. This is truly something he struggles with on a daily basis. But as with many things in life it is something that has to just get done, so it does.

By the way, you think teeth brushing is an issue....just wait until you have to get them to shave on a regular basis. For some reason, even Mr. GS who is fastidious in his appearance, hates to shave and will wait until the barber uses an electric shaver on him before he is cleanshaven. And its not like we haven't bought every razor known to mankind in the western hemisphere (including electric ones) to get him to shave. He recently admitted that he is afraid of cutting himself with a razor and we mentioned to him that if he shaved more often there will be less of a dense beard to get through (In fact his beard is so thick that the basic at-home electric razor does bubkas). I usually get him to shave by mentioning that he is starting to look like a chasidic Jew and that all he needs are the side curls. Being an avowed atheist  that observation will get him to shave within a few days.


The truth of the matter is that along with everything you need to do in order to help your child grow into a healthy and happy adult is working them through the basics of hygiene. For many aspergeans they simply do not care and need to be instructed as to the purpose and need, but for a large part of the community their hygiene related issues are an outgrowth of their sensory processing problems. The trick is to help them find a way to incorporate good health while making them feel comfortable in their own skin.

For books and products related to autism and daily living skills go to:

AAPC Publishing
Future Horizons
Jessica Kingsley Publishers
Soft Fingertip Toothbrushes
Oral defensiveness tools
Sensory Processing Foundation

I hope this helps a bit. Leave questions or comments and let me know.